Primary care obstetrics in rural western New York. A multi-center case review

Obstetric care in rural communities is in crisis due to the shortage of practitioners and the pressures of regulatory agencies on small obstetric units. We reviewed the records of 297 pregnant women presenting to the offices of 12 family physicians in rural areas of Western New York State. Local deliveries were done in rural hospitals that reported fewer than 500 deliveries per year. Family physicians obtained consultation in 36% of the pregnancies. Of these, care responsibility was transferred to an obstetrician 50% of the time (18% of all pregnancies). Two percent of the cases were transferred to a regional referral center. There was one perinatal death and one intrauterine fetal death in this series. Of the 222 deliveries by family physicians, oxytocin was used in 23%, narcotic analgesia was used in 15.3%, and outlet assist in 8.1%. Labors were somewhat longer than standard labor curves, and the overall cesarean section rate was 13.5%. We conclude that obstetric care by rural family physicians utilizing small rural Western New York hospitals is consistent with standards of care elsewhere when practiced in the context of an organized referral network.